Hui Liu, Xiaoxu Han, Yuqi Wang, Peng Wang, Xin Wang, Yunyun Yi, Xin Li
Department of Center of Integrated Traditional Chinese and Western Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Front Pharmacol. 2022 Mar 4;13:811357. doi: 10.3389/fphar.2022.811357. eCollection 2022.
Dual anti-retroviral therapy is the main proven valuable intervention type for treating naïve HIV/AIDS. Currently, no high-quality evidence is available regarding the best dual schemes. The aim of this study is to evaluate the effectiveness and safety of PIs/r-based dual therapy in treatment-naïve HIV/AIDS patients by using network meta-analysis. Randomized controlled trials of PIs/r-based dual therapy in treatment-naïve HIV/AIDS were searched based on Embase, PubMed and Cochrane library database from January 2006 to June 2021. Taking viral suppression rate, CD4T cell count changes from baseline as the primary indicator and adverse events rate as secondary indicator, the network meta-analysis was performed on Review Manager and STATA software. Heterogeneity was assessed by the Q statistic and I. We registered our protocol in Prospero with ID CRD42021275466. Among 15 randomized controlled trials (3,497 patients and 7 PIs/r-based dual therapy) were reviewed in this study. According to the forest map, DRV/r + INSTIs was more effective compared to triple therapy (TT) in viral suppression [OR 0.82, 95% CI (0.61-1.11)], in CD4T cell count changes from baseline [MD 1.9, 95% CI (0.7, 3.1), 86%], in adverse events [OR 0.98, 95% CI (0.68-1.39)]. Furthermore, SUCRA ranking analysis indicated that DRV/r + INSTIs was superior to TT in viral suppression (DRV/r + INSTIs 75.5% > TT 41.2%) and in immune construction (DRV/r + INSTIs 67% > TT 42%). In addition, DRV/r + INSTIs was similar to TT in adverse events (DRV/r + INSTIs 54.9% ≈ TT 54.7%). DRV/r + INSTIs was obviously superior to TT in viral suppression and immune reconstruction, and was not higher than TT in adverse events. https://www.crd.york.ac.uk/prospero/, identifier CRD42021275466.
双重抗逆转录病毒疗法是治疗初治HIV/AIDS患者的主要经证实有价值的干预类型。目前，尚无关于最佳双重方案的高质量证据。本研究旨在通过网络荟萃分析评估蛋白酶抑制剂/利托那韦增强剂（PIs/r）为基础的双重疗法在初治HIV/AIDS患者中的有效性和安全性。基于Embase、PubMed和Cochrane图书馆数据库，检索2006年1月至2021年6月期间以PIs/r为基础的双重疗法治疗初治HIV/AIDS的随机对照试验。以病毒抑制率、CD4T细胞计数相对于基线的变化为主要指标，不良事件发生率为次要指标，在Review Manager和STATA软件上进行网络荟萃分析。通过Q统计量和I²评估异质性。我们在国际前瞻性注册系统（Prospero）上以ID CRD42021275466注册了我们的研究方案。本研究共纳入15项随机对照试验（3497例患者，7种以PIs/r为基础的双重疗法）。根据森林图，在病毒抑制方面，达芦那韦/利托那韦（DRV/r）+整合酶链转移抑制剂（INSTIs）比三联疗法（TT）更有效[比值比（OR）0.82，95%置信区间（CI）（0.61 - 1.11）]，在CD4T细胞计数相对于基线的变化方面[平均差（MD）1.9，95%CI（0.7，3.1），86%]，在不良事件方面[OR 0.98，95%CI（0.68 - 1.39）]。此外，累积排序曲线下面积（SUCRA）排名分析表明，在病毒抑制方面（DRV/r + INSTIs 75.5% > TT 41.2%）和免疫重建方面（DRV/r + INSTIs 67% > TT 42%），DRV/r + INSTIs优于TT。此外，在不良事件方面DRV/r + INSTIs与TT相似（DRV/r + INSTIs 54.9% ≈ TT 54.7%）。DRV/r + INSTIs在病毒抑制和免疫重建方面明显优于TT，在不良事件方面不高于TT。https://www.crd.york.ac.uk/prospero/，标识符CRD42021275466。
